Why hysterectomy for many endometrial hyperplasias is often overkill

Conditions
October 21, 2014

A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed …

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What I love about being an anesthesiologist

Physician
October 20, 2014

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I wear a lot of hats in my job.  Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table.

Many days I spend in an administrative leadership role or conducting research studies.  These functions support the best interests of my patients as well as the science …

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Should we use antipsychotics to treat ADHD?

Conditions
October 19, 2014

Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior.

When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and a range …

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Running a code is a team sport

Physician
October 18, 2014

“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU.  The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her.  She wasn’t breathing, her heart wasn’t working, and despite the 30 people gathered in the room, in the end, she died.

Running a code, as we call it, means that someone is …

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The Fault in Our Stars: Should thyroid cancer be renamed?

Conditions
October 18, 2014

Josh Green’s novel — and recent film — The Fault In Our Stars (TFIOS) is a new classic of young adult fiction, deservedly famous, and it’s easy to see why. The story is simultaneously deeply sad and really funny, mostly due to the narrator, Hazel. She is an intensely likable 16-year-old, who charms you even while she explains, stoically, that she is dying of thyroid cancer that has spread to …

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To be or not to be: An artist in medicine

Education
October 16, 2014

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“Why would an artist want to go to medical school?”

It was a good question, and one of my favorite questions asked of me during my medical school interviews. I am what one might define as an artist, and yes, I really wanted to go to medical school. I was a photographer, musician, composer, and actor. I loved the arts and they …

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Why your doctor won’t refill prescriptions over the phone

Meds
October 13, 2014

Giving prescription refills is not quite as fun as it used to be. Years ago, we doctors would whip out our prescription pads — often sooner than we should have — and we’d scribble some coded language that pharmacists were trained to decipher. I’m surprised there were not more errors owing to doctors’ horrendous penmanship. On occasion, the Food and Drug Administration (FDA) would require a pharmaceutical company to change …

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Why do doctors still use pagers?

Physician
October 12, 2014

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I was on call last night.

Don’t get me wrong, this is not as bad as it sounds.

With over 20 partners sharing evening call, and residents getting the calls first, we do not have it bad at all. And certainly nothing like my obstetrician friends, who seem to go in every time they are on call for labor and delivery and then …

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The choice between motherhood and medicine

Physician
October 12, 2014

As the birth of our first child loomed on the horizon, I couldn’t help but worry.  As a first time mother and a pediatrician, I found the uncertainly coupled with too much knowledge of all manner of possible problems particularly unsettling.

In addition to worrying about my baby’s health, I grew increasingly concerned about how I would handle the balancing act that all working mothers must perform.  Having put motherhood off in order to complete …

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Why are so many people opposed to epidurals?

Conditions
October 10, 2014

To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger.

The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In …

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It’s time to talk trade-offs in health care

Policy
October 10, 2014

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An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking …

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The problem with primary care residency programs

Education
October 8, 2014

“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.”

I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with …

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How to give feedback to medical students

Education
October 5, 2014

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My student’s voice trembled as she answered my question.  “How do you think you’ve done so far?” I’d asked her.  We’d been together on the general medicine inpatient ward for two weeks — the midpoint of the rotation — and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance …

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3 ways to improve primary care access

Policy
October 4, 2014

Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits.

Unfortunately, too many Americans lack easy access to primary care.  Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. …

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MKSAP: 59-year-old woman with pain of the right foot

Conditions
October 4, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications …

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7 common reasons for refusing vaccines

Meds
October 3, 2014

The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S..

We have got to get more people immunized.

Essentially all of the cases were linked to “importations,” cases brought in from other countries …

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There is something very special about being a physician

Physician
October 2, 2014

Pretty much on a weekly basis I come across an article about how awful life is as a practicing physician. Articles focus on how unhappy physicians are with their jobs, with their hours, with their pay or with health care reform.

After almost a decade of practice, the fact is that I like my job.

Is it perfect? Absolutely not: quite far from it, in fact. There are certainly many times when …

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